"We took this initiative on as a patient safety measure," said Dr. John Deledda, vice president of medical affairs.

He acknowledges there was some initial resistance, but he said anecdotal evidence shows absenteeism is down.

The Health Collaborative found 87 percent of all medical employees were vaccinated last year, up 7 percent over the previous year.

"Of course, there are many who do not wish to get the shot," said Dr. Steve Englender, of the Cincinnati Health Department.

Their reasons range from medical to religious to personal preference.

TriHealth offered all of its 10,800 employees free flu shots and gave them until Nov. 16 to get them. Employees who did not get the shot were sent letters telling them to get the shots by Dec. 3 or provide a valid reason for declining, a company spokesperson said.

Tri Health declined comment Wednesday, but one employee who contacted News 5 said they'd been sent a termination letter for refusing the shot.

"WHY ARE people being forced?" the employee, who asked to remain anonymous, said in an email. "I never signed anything stating I would submit to a flu shot."

Cincinnati's health department highly recommends, but does not mandate, its staff to get the shot.

Dr. Bill Frist, former Senate majority leader, who was in Cincinnati on Wednesday at the Health Collaborative Awards Dinner, emphasizes vaccinations save lives.

"Health facilities do have to be kept at a different standard than you or even me today, not practicing medicine," Frist said.

Health officials believe mandatory is the ethically responsible approach to flu season, but it's still a patchwork-in-progress.

Cincinnati firefighters and emergency medical technicians are not required to get a flu shot, although most do.